In June 2019, a horse with neurological disorder was diagnosed with West Nile virus (WNV) in Boa Viagem, a municipality in the state of Ceará, northeast Brazil. A multi-institutional task force coordinated by the Brazilian Ministry of Health was deployed to the area for case investigation. A total of 513 biological samples from 78 humans, 157 domestic animals and 278 free-ranging wild birds, as well as 853 adult mosquitoes of 22 species were tested for WNV by highly specific serological and/or molecular tests. No active circulation of WNV was detected in vertebrates or mosquitoes by molecular methods. Previous exposure to WNV was confirmed by seroconversion in domestic birds and by the detection of specific neutralizing antibodies in 44% (11/25) of equids, 20.9% (14/67) of domestic birds, 4.7% (13/278) of free-ranging wild birds, 2.6% (2/78) of humans, and 1.5% (1/65) of small ruminants. Results indicate that not only equines but also humans and different species of domestic animals and wild birds were locally exposed to WNV. The detection of neutralizing antibodies for WNV in free-ranging individuals of abundant passerine species suggests that birds commonly found in the region may have been involved as amplifying hosts in local transmission cycles of WNV.

Aim:To analyze the One Health approach regarding rabies surveillance, control, and prevention in Brazil's Ceará State, exemplified by a detailed description of rabies cases that occurred over 18 years. Methods:We described in depth the history, case development, surveillance, and prevention measures of all cases of human rabies, 2004-2021. We analyzed patient charts and reviewed technical reports of the State Health Secretariat, in addition to analysis of personal notes from field missions. Results:All six cases occurred in rural areas. The affected people came from resource-poor communities. The state rapid response team performed comprehensive actions and seminars in collaboration with the Municipal Health Secretariats and other stakeholder groups. Patients and their relatives were not aware about the risk of wildlifemediated rabies. A high number of wild animals (marmosets) kept as pets were collected in the communities. Only one patient presented at a primary health care center before the onset of symptoms but did not receive any postexposure prophylaxis due to logistic problems. Even after onset of symptoms, in all cases, the suspected diagnosis Conclusion: Rabies in Ceará is a wildlife-mediated disease of the most vulnerable rural populations. There is a need for ongoing integrated surveillance and control measures, information and education campaigns, and professional training, especially focusing on wildlife-mediated rabies. An integrated One Health approach -as exemplified by the presented rabies control program in Ceará -is critical for human rabies elimination.